Initiation of dialysis is not delayed in whites with progressive renal failure

Black and hispanic patients sustained on maintenance hemodialysis have better survival than their white counterparts. It is speculated that this is partly because of delayed initiation of dialysis in whites. We retrospectively analyzed 220 patients with chronic renal failure started on hemodialysis at our institution from 1987 to 1994 to detect any racial differences in uremia severity at initiation of dialysis. The 220 study subjects (120 women, 100 men) included 139 blacks (63%), 61 whites (28%), 16 hispanics (7%), and 4 asians (2%) of mean (+/- SD) age 53.5 +/- 15.6 years at referral. At initiation of dialysis, nonwhites had a higher mean serum creatinine concentration (sCr) than whites (12 +/- 5.1 vs 8.8 +/- 3.7 mg/dl; p = 0.001). Mean hematocrit was lower in nonwhites (24% +/- 5.8%) than whites (28% +/- 4.8%; p = 0.001). Logistic regression analysis with adjustment for potential confounders showed that nonwhites were three times more likely than whites to have a hematocrit value of less than 22% at initiation of dialysis (odds ratio, 3.0; 95% confidence interval [CI], 1.11-7.6; p = 0.02). Furthermore, the higher the sCr at initiation of dialysis, the higher the odds of having a hematocrit value of less than 22% (odds ratio, 1.1; 95% CI, 1.03-1.12; p = 0.005). We conclude that at initiation of dialysis, nonwhites have higher sCr as well as more severe anemia than whites, which suggests that initiation of dialysis is not delayed in whites relative to nonwhites.